The Sunday Spin: Avoiding medical school burnout

medical school residency burnout

The Sunday Spin, Episode 8: “Rivers and Roads”

The Self-Titled Debut Album by The Head and the Heart

For context, this week’s Spin is coming directly from the passenger seat of a sports utility vehicle. I’m sitting next to Donny, my childhood buddy, as we roam the Pacific Northwest…

This trek marks an almost four-year anniversary since we first made the journey to Portland, Oregon, catching an impromptu firework display and an energetic performance by a French Electronic-Pop duo called Stereo Total. The trip could not have come at a better time! Scheduled right after my USMLE Step 1 Exam, it was the fun and regenerative excursion I needed. Not only was the trip memorable, but it also generated a fervor for travel deep within my bones.

Prior to our adventure, my vacations had consisted of study binges and family road-trips laden with crisis. By the time I reached college, I would avoid breaks like the plague. I became intimately acquainted with the 24-hour reading room at Shields’ Library, getting “Lost In My Mind” instead of enjoying life…

Don’t get me wrong, I love studying as much as the next “type A” personality, but there comes a point when your productivity tanks and work becomes futile.

How do you avoid this diminishing margin of return and inevitable “burnout?”

Well, you can do what I did and push through it, spiraling further into exhaustion o Or, you can capitalize upon my mistakes and heed this simple advice: “Take time for yourself.”

At face value, this seems easy! Of course, I’m going to take care of myself, sleep well, eat right, and exercise… Sure! Let me know how that’s working for you. If you are anything like me (heaven forbid), you find it hard to put yourself before the books and before others. Sadly, as medical professionals, we are faced with endless tasks and demands. And until you learn to let go, you are going to drown in the workload.

Unfortunately, I learned this sad truth rather late in my “academic career”…

I know. It feels selfish to go on an enjoyable vacation or even to take the time to exercise or go shopping instead of studying. Don’t be plexin’ (worrying) because here’s a dirty little secret: unless you skip studying and working altogether, you’re probably going to do just fine!

I’m sure what I am saying is nothing new, we are reminded frequently by our mentors to “Stop and smell the roses.” However, an extra reminder doesn’t hurt…

You have to be proactive about your health and vacations, otherwise “burnout” will creep in like mold on that loaf of sourdough bread sitting on my counter, which my roommate and I are passively avoiding throwing out (little does he know, I once kept a tortilla so long that it looked more like an avocado than compressed flour by the end).

So, get out there and have some fun! Especially those of you on the cusp of taking your USMLE Examinations!

Here is some tune-age to accompany your adventures, courtesy of The Head and the Heart.

medical school burnout

Forged in Seattle, Washington, The Head and the Heart was a conglomeration of transplants that met via local open mic nights. Their songs were simple. Filled with beautiful harmonies tied together by an acoustic guitar, garnished with the tinkling of ivories or swells of violin strings. They cultivated a rustic tone that could only be harvested in the Pacific Northwest or the “Drrrty South.”

The Head and the Heart was quickly be signed to Sub Pop Records after producing the single “Down In The Valley in 2009. The band promoted themselves by selling burned copies of  “Down in the Vally” wrapped in a homemade denim sleeve (much classier than Alice Cooper’s album, School’s Out for Summer, which featured an inner sleeve shaped like panties). Demand for the denim adorned discs outgrew the supply, as The Head and the Heart opened for bands such as Vampire Weekend, Death Cab for Cutie, My Morning Jacket, The Decemberists, and Iron and Wine. And the band would complete their album and release it in 2011.

The Head and the Heart’s debut self-titled album is a masterpiece with songs craftily sewn together, opening brightly with “Cats and Dogs” which abruptly morphs into “Couer d’Alene.” The ebb and flow of energy within this album is incredible.  The melodic drone of “Down in the Valley,” “Rivers and Roads,” and “Heaven Go Easy on Me” juxtapose nicely with pulsating breakdowns that get your toes tappin’ and hands clappin’.

Specifically, “Rivers and Roads” invokes an element of nostalgia that brings me back to medical school. I can’t help but think of my classmates and ponder how they are doing at their respective residencies scattered across the United States.  My favorite single off the album has to be “Lost in My Mind,” a jubilant song of encouragement, reminding us to care for our brethren. An important message, needed now more than ever!

Whether it be raining “Cats and Dogs,” snowing “Down in the Valley,” or sunny along your “Rivers and Roads,” get out there and explore!

Hella,

theSpindoctor

Everything you need to know about SketchyPath

sketchypath

SketchyPath is coming!  Our doctors and medical school students have been working around the clock to create our new pathology course, and Part 1 is now ready!  We wanted to make sure May and June Steppers get at least some part of SketchyPath before their USMLE Step 1 test, so we are releasing Part 1 first.  The rest of SketchyPath will be released Fall 2017.  Part 1 arrives Wednesday, March 29!

Here are the official details:

Course:

  • 30+ fun, informative video sketches on Pathology
  • 600+ minutes of entertaining medical education
  • A slew of new characters, existing symbols, and way too many puns!

Dates:

  • SketchyPath Part 1 will be available starting Wednesday, March 29
  • You can pre-purchase SketchyPath Part 1 on SketchyMedical starting today (all pre-purchased subscriptions will begin on March 29, when the new pathology course officially launches)

Price:

  • SketchyPath Part 1 will be grandfathered into our existing SketchyMedical bundle subscription.  So if you currently subscribe to the SketchyMedical bundle, then you will automatically get SketchyPath Part 1 for FREE!  You don’t need to do anything, and you will automatically be able to view the new pathology course when you log into your SketchyMedical account on March 29.
  • SketchyPath (Part 1) is available now at $29.99 for each 6-month subscription.  You can pre-order now, and your subscription will start on March 29.
  • If you currently subscribe to just SketchyMicro or SketchyPharm, you will be able to purchase SketchyPath (Part 10 for only $19.99 for a 6-month subscription!  Just log into your existing SketchyMedical account and you will automatically see the option to purchase it at the discounted price.

If you have any other questions, please leave a comment below or reach out on Facebook.

Get ready!

USMLE Step 1 Study Plan

Travis is a MS2 student and SketchyMedical user, and getting ready for his USMLE Step 1! We will be following along on his journey and USMLE Step 1 journal as he prepares for the big day.  He studies at the University of Texas Health Science Center at San Antonio. Check out his first post here, and read on for his USMLE Step 1 study plan.

usmle step 1 study guide

Since my last post, I have taken my last module final of pre-clinicals, passed the Comprehensive Basic Sciences Exam given by my school, shadowed a crazy awesome family physician who I really admire, and took a nice, week long break to enjoy my personal life – taking time to visit family and work on our garden. It’s been very nice. I feel recharged and ready to do some serious studying for the USMLE Step 1. In my last post, I promised more details about my USMLE Step 1 study plan. Here we go!

My USMLE Step 1 Study Plan:

From February 27 to April 27, I have 8 and a half weeks before D-Day. I will spend 5 of those days on a vacation with my wife. I also plan to spend most of my weekends living life and maintaining a work/life balance. So when I refer to weeks I will be referring to weekdays. That being said, I’ll be doing the occasional 3-hour SketchyMedical session on the weekends to help me get through SketchyPharm, and also to review SketchyMicro (fairly early) in my 8-week study period.

I will spend the first three out of eight weeks zooming through First Aid for the USMLE Step 1 one section at a time. These will be my “First Aid Weeks”. I am not trying to memorize everything in First Aid during this time. My goals are to get a big picture look at what topics I can expect to see on the exam and refresh my memory a bit on subjects I have not seen in several months.

During the last five weeks of my dedicated study time, I will be doing UWorld questions everyday and referring back to First Aid as needed. These will be my “UWorld Weeks.” This is really the most crucial part of my study plan. My First Aid Weeks will set my framework of knowledge, and my UWorld Weeks will solidify that framework and flesh it out. In general, I plan to spend about 6-7 hours per day studying (from about 7:30 AM – 3:30 PM with an hour of extra time thrown in there for lunch and exercise). In the afternoons I plan to tutor my cousin in math, do some chores around the house, and possibly work on my Spanish. That last part might be too ambitious, but my limited clinical experience so far has definitely shown me that some Spanish proficiency would be unbelievably helpful for the future.

usmle step 1 study plan guide schedule
Details about my First Aid Weeks: You can see what subjects I will be focusing on each day in my calendar here

I’ve given myself a day for each section in First Aid with a couple exceptions:

  1.  I will not be spending a day on the Pharmacology or Microbiology sections of First Aid. Instead, I will get most of this information from SketchyMedical and use the First Aid sections as a reference while going through SketchyMicro and SketchyPharm.
  2. I have given myself 2 days each for Neurology and Hematology/Oncology because these were the most difficult modules for me. In general, I plan to power through the First Aid section for that day (most sections are about 20-40 pages), and then do a round of UWorld questions from that section to end the day.

usmle step 1 study plan guide schedule

Details about my UWorld Weeks: I’ve already done a couple hundred UWorld questions throughout the last year and a half. That leaves me with about 2250 questions remaining. With ~2250 questions left in UWorld, that is 57 blocks of 40 questions (40 is the maximum number of questions you can include in one practice test). If I use timed mode to keep things as much like the real test as possible, it will take me one hour to take each test. After that, if I review the correct answers (which is absolutely crucial!) for another one hour, I will use up a total of two hours per test. That is 114 hours to take and review 57 tests. Working six hours per day that will take me 19 days. If I work 5 days per week it will take me just under 4 weeks to get through UWorld once. That means that in my five weeks I’ll be able to get through UWorld one time for sure with some time at the end to go through some questions again. I have to admit, I’m concerned that it might take me more than an hour to review each block of questions. But even if I average something more like an hour and a half, I will be able to get through UWorld once in 4.75 weeks (I won’t force you to walk through the calculation a second time), which still fits my 5 week time frame.

A few additional notes:
• During my workouts I will be listening to Goljan. There are 37 hours of recordings here. He walks through the pathology in a really succinct way and is great about drawing connections between several subject areas.  Listen to it while you workout, drive, etc. Every little bit helps! Unfortunately, I won’t be able to take advantage of SketchyPath before my test date.
• After I’ve finished my First Aid weeks, I will spend 10 to 15 minutes each night before bed looking through the First Aid Rapid Review section. It is overwhelming to look at this section before you’ve completed all your modules, but it makes a lot more sense to me now than before, and as I refresh my memory going through the First Aid sections one at a time, I think the Rapid Review Section will make even more sense.
• I will be squeezing in SketchyMedical whenever I have the chance, including while I eat, do dishes, etc. I will also have some dedicated periods on the weekend that I end up watching Sketchy. I’m breaking it up like this because I don’t want to binge watch my way through the videos. I tried to do that with the viruses before my microbiology final and it all mushed itself together in my mind.

That’s my full battle plan for preparing for this big exam. Every single one of my classmates is doing something different. I probably spent about 2-3 hours building this plan, and I tried to be realistic with how much studying I could do in a day before getting totally overloaded or so distractible that studying is no longer worth it.

When you are building your study plan:

  • be realistic with yourself about what you can reasonably absorb in one day
  • prioritize your weakest subjects
  • and maintain some balance between studying and the rest of your life

Good luck, and I would love to hear your USMLE Step 1 study plan!

Travis

The Sunday Spin: the issue of the Medical Specialty

The Sunday Spin, Episode 7: “You’ve Got To Hide Your Love Away”

Help! by The Beatles

medical specialty the match

“What specialty are you interested in?”

A seemingly innocuous question that, as a medical professional, you will be asked the remainder of your career… From the time we interview for medical school, to the end of residency, mentors use this question to measure us up.

 

How will you combat this question?

 

Some folks lie and claim to be interested in whatever rotation they are on. While others are a little too honest in divulging their true intentions, such as monetary gain, prestige, or (my personal favorite) “work-life balance” (I’m looking at you dermatology and peds…)

However, both of these responses can be problematic as a trainee…

The problem with the former response is that most Attendings figure out pretty quick whether or not you are actually interested in their field. In fact, feigning interest can lead to more strenuous demands, as residents and Attendings attempt to “weed out” those who don’t fit the mold. For whatever reason, this “moldy” way of thinking tends to be more prevalent among the surgical specialties; where demanding schedules are seen as a right of passage, rather than a violation of rights.

If you are interested in a given specialty, definitely indicate and voice your passion because this will alert your supervisors to be more observant (should you need a letter of recommendation in the future). It will also help the residents to gear their teaching towards you. But be careful, because this can be a double-edged sword… As I eluded to earlier, supervisors tend to challenge those interested in the field in order to provide an adequate representation of what a career in that specialty would be like.

 

Thus, if you are not 100% decided on a career path, it is best to be coy about your aspirations and interests. I found this to be especially true for the third year of medical school…

The third year of medical school is definitely the most diverse year of our medical school education. When else do you get exposure to all the various medical specialties with little pretense or expectation? Many find this year daunting, as you are thrown into novel situations daily and required to perform.  Before you start hyperventilating, don’t worry – you are a third year student, you don’t have much experience, and your supervisors (for the most part) understand that.

For those of you going into your third year now, enjoy it! Take the rotations as an opportunity to learn what you like and what you dislike.  And keep a totally open mind, for you never know what you are going to like – as the old adage goes, “Don’t knock it ‘til you try it!”

In fact, my favorite rotations during my third year medical school were those that I never expected to like. I was lucky in knowing that I wanted to do Outpatient Pediatrics early on in my training. But, that didn’t stop me from enjoying my Surgery, Gynecology, and Psychiatry rotations. I absolutely loved my surgery rotation, which was quite unexpected given that I ultimately want to be as far away from the operating room as possible in my career choice. Yet, I found myself drawn to the grueling hours, camaraderie, innovative techniques, and the magnificence of seeing human anatomy in its living form. Similarly, I still relish the stories and unique experiences I gained from my time at the VA Psychiatric Unit. Those outlandish stories will stay with me for the rest of my life.

Conversely, my worst rotation during third year was none other than Pediatric Wards.  My rotation was horrendous and left me questioning whether Pediatrics was a good fit for me. In retrospect, I realize that team dynamics and hospital culture had a huge impact on my perception of the rotation. So, you can’t let one bad experience dictate your future either…

Choosing a career path is difficult and given the amount of burnout experienced by physicians, many of us choose the wrong path somewhere along the way.  So, how do we avoid this folly and choose the right path and gain eternal happiness?

If I knew that, I’d be a millionaire, not a doctor…

But, what I can tell you is to keep an open mind and try to learn from and enjoy every rotation the best you can. Like a boyfriend or girlfriend, no one person or field is “perfect”.  You just have to find the specialty which fits you the best, that motivates you and at which you enjoy spending your time. If you wake up every morning fretting work, then that is a surefire sign that this position isn’t for you…

Hopefully, this revelation occurs in training and not several years into a career. And even if it does happen late in your career, don’t see it as a sign of failure, but instead as a strength in that you can recognize your dissatisfaction and take action to do what makes you happy.

For me, that is making children cry… Just kidding 😉

beatles help! medicine

To coincide with this spin’s topic, I thought it would be entertaining to discuss the intention of John Lennon’s classic You’ve Got To Hide Your Love Away“. Now, I’m not the biggest Lennon fan. If I had to rank the Beatles, I’d probably go Paul, George, John, and finally Ringo. If I get to include George Martin and Pete Best in that list, I’d probably put Martin ahead of Lennon and Best after… Anywho, back to the song.

“You’ve Got to Hide Your Love Away” is a lovely number that is rather an enigma. Many have speculated about the true meaning of the song. At face value, the song is about unrequited love, but the nature of this affair is not revealed in the content of the lyrics. Theories about the meaning have ranged from keeping his marriage to Cynthia Powell a secret, an ode to Brian Epstein (the Beatles manager, and closeted homosexual, who reportedly had a crush on Lennon), or Lennon’s need to isolate his true self from the public eye. Personally, I think the song holds a similar sentiment to Norwegian Wood (This Bird Has Flown), which was about one of John’s extramarital affairs that took place at former band mate Pete Asher’s place. The tone of the song is somber and introspective, as Lennon contemplates revealing his true passion.

“You’ve Got to Hide Your Love Away” certainly isn’t the premier track on the Beatles’ fifth studio UK album released in 1965. Help! featured a number of tracks that overshadowed “You’ve Got to Hide Your Love Away,” including “Ticket to Ride,” “Help!,” “You’re Going to Lose That Girl,” and the Beatles’ most covered song, “Yesterday.” Speaking of covers, “You’ve Got to Hide Your Love Away” has been covered by numerous artists, including: the Beach Boys, Eddie Vedder, Joe Cocker, and (my personal favorite) Oasis.

Much like A Hard Day’s Night, Magical Mystery Tour, and Yellow Submarine, Help! was an album based around music featured for the film (basically an hour and a half long musical story before the days of MTV and VH1). Help! was released in the UK as with the first side featuring songs from the movie and the second side with additional songs; whereas the US release featured instrumentals on the flip-side.

 

Help! was a unique album for the Beatles, coming just before Rubber Soul and Revolver, when the Beatles diverged in their art, inventing new ways of producing music and focusing on writing rather than touring. To this end, “Yesterday” was a landmark song for the Beatles, in that it was their first song with an orchestra accompaniment. We have George Martin to thank for this stroke of genius, but  it took a great deal of convincing to get McCartney to agree to the strings… This paved the way for tracks like “Eleanor Rigby,” “Sgt. Pepper’s Lonely Hearts Club Band,” and “When I’m Sixty-Four,” among others. And the best part of “Yesterday,” was that the single featured my favorite track on the album as a B-side, Act Naturally.

I hope this post “helps” those of you going through third year. And to those who recently selected your match list, may the odds be ever in your favor!

 

Help-fully,

TheSpinDoctor

USMLE Step 1 Journal: Introduction

Travis is a MS2 student and SketchyMedical user, and getting ready for his USMLE Step 1! We will be following along on his journey and USMLE Step 1 journal as he prepares for the big day.  He studies at the University of Texas Health Science Center at San Antonio.

usmle step 1 journal

 

Howdy! My name is Travis. I’m finishing up my second year of medical school. As a second year medical student, I have this big quiz coming up in late spring. I think it’s called the Step? Step 1? It’s something like that. Anyway, everyone seems pretty riled up about it.

To be honest, I’m feeling a little intimidated about it as well, although that trepidation has less to do with the exam itself, and more to do with the minute-by-minute spring study schedules I’ve seen from many of the MS3s who did this last year. How does anyone stay on a schedule like that?!? Seriously though, how does anyone know that it will take them exactly an hour and seventeen minutes to go over the vasculitides? What if they need more time? I just don’t quite work like that. It would take me the eight full weeks to come up with a schedule like that, and then my study time would be over. So that’s a no-go for me. My hope in this series of posts is to give those of you who are like myself, and could use an alternative to a minute-by-minute schedule.

I want to give you guys some idea what my goal is for performance on the Step 1 exam. I want to be a Family Physician. I have been interested in family medicine for a long time and the farther I get into my education, the more sure I am that family medicine is a great fit for me. You may or may not know that family medicine is one of the least competitive fields to get into. That means I don’t have to absolutely rock the Step 1 to be competitive in my specialty of interest like I would if I was interested in dermatology.  That being said, I still want to do well on this exam. The better I prepare now, the more prepared I will be as a future physician no matter what specialty I choose. I’d like to score a 245 – I’ve set a high expectation on purpose. That way, if I score lower than my goal, like a 235 or 230 I won’t be disappointed.

I haven’t worked out all the details for my study schedule yet, but in my next post I’ll have some nice photos of my schedule for the spring as well as a description of how my schedule will work.

At my school, our MS2 curriculum wraps up on February 22 and we are not required to be back until July 10th. That means we have those 5 months to use as we see fit (dedicated Step study, research, elective rotations, early clerkships, vacation, etc). I will start my official USMLE Step 1 studying Monday February 27th, and will be taking a week off for a spring break vacation with my hard-working wife because balance between school and life is important beyond measure. Then, I will take my test on April 27th. That gives me about seven and a half weeks of dedicated study time.

Here are the resources I will use:

UWorld USMLE

  • The common theme in the advice I’ve received is that practice questions should be the absolute core of your studying, so this is where I will be spending the majority of my time. Our school uses some of our tuition and fees to buy this QBank for us (a.k.a. we didn’t have a choice). For that reason, I see no reason to spend money on another QBank like Kaplan. Also, I have regularly heard that the UWorld questions are the most similar to actually Step questions in their length and difficulty.

First Aid for the USMLE Step 1 2017

  • I will use this at the beginning of my study time to refresh my mind about subjects long forgotten, and then as I go through the QBank, this will be my essential reference. I am using the 2016 version instead of 2017 because I have had this 2016 edition with me since the middle of MS1 year, so it is full of information I have added, things I found important while studying, etc. I think those notes will be valuable. Also, I don’t want to spend $45 for a 2017 edition that is basically the same as what I already have.

Sketchy Medical (for both micro and pharm)

  • I know this is a Sketchy blog and you might think, “Of course he has to mention that,” but in all honesty I don’t know how I would learn the necessary pharmacology or microbiology without sketchy. Sketchy gives me the basic framework I need for every bug and drug. After I’ve learned the Sketchy illustrations, additional information and caveats stick much better in my mind.
  • By far my weakest area has been pharmacology. That’s why I am prioritizing SketchyPharm within my top three study activities, even though the amount of video I need to watch is a little overwhelming.
  • And by the way – SketchyPath (Part 1) comes out on Wednesday, March 29!

Practice CBSEs offered once a month by my school

  • From my experience with previous standardized exams, it really helps to take some practice tests before the real thing. These are particularly great because they’re free (or already included in my school fees…).
  • It is especially helpful to take these practice CBSEs with a test of this magnitude – to build your endurance and stamina for the eight hour Step 1 monster.

The Goljan Series

  • I wanted something to listen to while driving, working out, etc. In forty-ish hours, Dr. Goljan goes through almost every one of the basics you need to know. He moves fast, but what I love about these lectures is the way he makes connections between different topics.

I haven’t had time to fully construct my study schedule yet, but my goal is to get through all of First Aid, all of SketchyPharm (I’ve only watched a few videos so far and there are 27+hours worth), and all of the UWorld QBank once. I will be planning my daily study hours accordingly. When planning my daily/weekly study schedule, I will also be making sure I include time to exercise, eat well and get enough sleep.I will also schedule time to take care of our garden, tutor a family member in math, cook dinner with my wife, and spend time with my grandma. I include these things because they are a crucial part of my study schedule and making sure I have a study life balance. They will keep my heart, mind, and body in proper shape for all the hard studying I will be doing. Your equivalent of these good-for-your-soul activities should be part of your schedule too. Far too many hard working, stressed-out medical students push these things to the backburner, thinking they are doing themselves a favor, when in reality they are going to end up over-worked, super-stressed, and burnt-out.

More details to come with the next post, after I’ve put everything together!

Until then,

Travis